Charles Cullen

• 1. Introduction

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  Charles Cullen told detectives that he had killed as many as 40 patients, and that figure marks only the beginning of the uncertainty around him. Investigators have confirmed at least 29 of those deaths. Researchers who studied his career have suggested the real toll could be as high as 400. Most of the deaths can never be proven, because the records that would show them are missing.

  Cullen was a nurse, a person whose job rests on trust at the bedside. How did one man move through so many hospitals while patients died around him? Who noticed something was wrong, and why did nobody stop him sooner? And what did the health care system change once it finally learned his name?

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• 2. Before the Hospitals

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  Charles Edmund Cullen was born on the 22nd of February 1960 in West Orange, New Jersey, the youngest of eight children. His father, Edmond, a bus driver, died on the 17th of September 1960, when Charles was only seven months old. Cullen later described his poor childhood as miserable. He said schoolmates and his sisters' boyfriends bullied him constantly. Around the age of nine, he made the first of many suicide attempts by drinking chemicals from a chemistry set.

  His mother, Florence, was born in England and came to the United States after World War II as a war bride. She was killed in a car accident on the 6th of December 1977, when Cullen was 17 and a junior in high school. He later claimed that the family was not told right away. He also claimed that the hospital cremated her rather than return the body.

  In 1978, Cullen graduated from West Orange High School and enlisted in the United States Navy. He was assigned to the submarine USS Woodrow Wilson. He passed basic training and the psychological screening required of submarine crews, who might spend as long as two months at a time submerged. He rose to petty officer second class on the team that operated the vessel's Poseidon missiles. Even so, he never fit in, and crewmates hazed and bullied him as classmates once had.

  A year into his service, his leading petty officer found him seated at the missile controls in a surgical gown, mask, and gloves instead of a uniform. Cullen was disciplined and never explained the costume. The Navy moved him to a calmer job on the supply ship USS Canopus. He attempted suicide and was committed to the Navy psychiatric ward several times for depression. In 1984 he was discharged for reasons that were never disclosed.

  Soon afterward, Cullen enrolled at the nursing school of Mountainside Hospital in Montclair, New Jersey. He graduated in 1987 and took a job in the burn unit of Saint Barnabas Medical Center in Livingston. Shortly before he received his nursing license that year, he married Adrienne Taub, a computer programmer. Their first child arrived later in 1987, and a new career was under way.

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• 3. New Jersey Beginnings

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  The earliest murders Cullen later confessed to took place at Saint Barnabas, on the 11th of June 1988. That day he gave a patient a lethal overdose of intravenous medication. He eventually admitted to killing several more patients there, including a man with AIDS who died after an overdose of insulin. In January 1992, Cullen left after hospital authorities began investigating contaminated IV bags. Investigators later concluded he was most likely responsible, and the contamination was tied to dozens of patient deaths.

  A month after leaving, Cullen started in the coronary care unit at Warren Hospital in Phillipsburg, New Jersey. In August 1993, a 91-year-old cancer patient told her son that Cullen, who was not her assigned nurse, had entered her room and injected her. She died the next day. The hospital gave Cullen and several other nurses a lie detector test, and all of them passed. He later pleaded guilty to killing her with an injection of digoxin.

  His home life was falling apart at the same time. Cullen drank heavily, and his wife was alarmed by his strange behavior and his abuse of the family dogs. She filed for divorce in January 1993. Four months later she sought a restraining order, fearing he might endanger her and the children, and it was granted after he had been treated at two psychiatric institutions. The divorce became final in December 1994, and he moved into a basement apartment in Phillipsburg.

  In March 1993, Cullen broke into a co-worker's home while she and her young son slept, then left without waking them. He began stalking her, and she reported him to the police. He pleaded guilty to trespassing and received one year of probation.

  At the end of 1993, Cullen left Warren for a three-year stint in the intensive care unit of Hunterdon Medical Center in Flemington, where he received an employee award. He said he harmed no one in his first two years there, but the hospital records from that period had been destroyed by the time of his arrest. He did admit to murdering five patients between January and September 1996, again with digoxin. Morristown Memorial Hospital hired him next and soon fired him for poor performance. After six months without work, he sought treatment for depression in the Warren Hospital emergency room and was briefly admitted to a psychiatric facility.

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• 4. The Lehigh Valley Years

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  In February 1998, the Liberty Nursing and Rehabilitation Center in Allentown, Pennsylvania, hired Cullen to staff a ward of patients who depended on respirators. On the 7th of May 1998, Francis Henry, 83, was rushed to Lehigh Valley Hospital after choking on his own vomit. Doctors there contacted Henry's Liberty nurse, Kimberly Pepe, three times to ask why he had received a toxic dose of insulin. Within two months she was fired, even though she said she had not given him the medication.

  In her 2000 wrongful termination lawsuit, Pepe accused Liberty of violating her civil rights. She also accused it of failing to investigate Cullen, who she said already had performance problems and was working the evening Henry fell ill. She settled out of court in 2001, and the terms were sealed. In December 2003, Liberty's parent company, HCR Manor Care, denied her claim. It said an internal inquiry in 1998 had not tied Cullen to Henry's death. It said he was fired later that year for mishandling medication, after he entered another patient's room holding syringes and the patient's arm was broken. Cullen filed for bankruptcy in 1998.

  From November 1998 to March 1999, Cullen worked at Easton Hospital in Northampton County, Pennsylvania, hired through a temporary agency called Healthforce of Harrisburg. John R. Sakala, 86, was admitted on the 2nd of December 1998 with a persistent cold and inexplicably died the next day. A hospital pathologist found abnormally high insulin in his blood, but the county coroner never investigated.

  Ottomar Schramm, 78, was receiving treatment for a seizure in the hospital's 4 North West wing when Cullen worked two overnight shifts there, between the 29th and the 31st of December 1998. On the 30th of December, Schramm's blood tested positive for digoxin he had not been prescribed, and he died the next day. The hospital's owner, Two Rivers Corporation, alerted Northampton County Coroner Zachary Lysek in January 1999. Lysek feared an angel of death had struck, but in 2000 he closed his inquiry as inconclusive after hospital officials said their own probe had found no suspect. Schramm's widow sued the hospital and other parties in January 2001.

  In March 1999, Cullen joined the burn unit of Lehigh Valley Hospital-Cedar Crest in Allentown, where he murdered one patient and tried to kill another. A month later he resigned and took a job in the cardiac care unit at St. Luke's Hospital in Bethlehem, Pennsylvania. Over the next three years he killed at least five patients there and tried to kill at least two more. On the 11th of January 2000, he lit a charcoal grill in his bathtub, hoping to die of carbon monoxide poisoning. Neighbors smelled smoke and called the fire department and police. He went to a hospital and then a psychiatric facility, and was home again the next day.

  A co-worker at St. Luke's finally raised an alarm after finding medication vials in a disposal bin. The drugs had no resale value and no recreational use, so their theft was highly unusual. An investigation showed Cullen had taken them. The hospital offered him a choice: resign with a neutral recommendation, or be fired. He resigned and was escorted out in June 2002.

  Seven of his co-workers later told the Lehigh County district attorney they suspected he had used drugs to kill patients. Investigators never examined his past, and the case was dropped nine months later for lack of evidence.

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• 5. Somerset and Arrest

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  In September 2002, Cullen started work in the critical care unit of Somerset Medical Center in Somerville, New Jersey. He began seeing a local woman around that time, yet his depression deepened. By mid-2003 he had killed at least 13 patients there and tried to kill at least one more, using digoxin, insulin, and epinephrine. One attempt, on the 18th of June 2003, targeted a patient named Philip Gregor. Gregor survived, was discharged, and died six months later of natural causes.

  Somerset's staff began to see a pattern in Cullen's behavior. He entered the rooms and the computer records of patients who were not his. The hospital's computerized drug-dispensing cabinets showed him requesting medications his patients had never been prescribed. Many orders were canceled right away, and many requests came within minutes of each other.

  In July 2003, the executive director of the New Jersey Poison Information and Education System warned Somerset officials about at least four suspicious overdoses. She said they pointed to an employee killing patients. By October, Cullen had killed at least five more and tried to kill another. When a patient died of low blood sugar that month, the hospital notified the New Jersey State Police. That patient was his final victim. State officials later rebuked the hospital for not reporting a nonfatal insulin overdose Cullen gave in August. Somerset fired him on the 31st of October 2003, ostensibly for lying on his job application.

  Cullen was arrested at a restaurant on the 12th of December 2003 and charged with one count of murder and one of attempted murder. Two days later, he admitted to homicide detectives Dan Baldwin and Tim Braun that he had murdered Florian Gall and tried to kill Jin Kyung Han, both Somerset patients. He also described a career that had lasted 16 years.

  In April 2004, Cullen pleaded guilty before Judge Paul W. Armstrong in New Jersey to killing 13 patients and attempting to kill two more by lethal injection at Somerset. His plea agreement promised cooperation with authorities in exchange for prosecutors not seeking the death penalty. A month later he pleaded guilty to three more New Jersey murders. In November 2004, in an Allentown court, he pleaded guilty to killing six patients and trying to kill three others. He disrupted the hearing by chanting at the judge, "Your Honor, you need to step down," and was ordered restrained and gagged.

  On the 2nd of March 2006, a New Jersey court sentenced him to 18 consecutive life sentences. He will not be eligible for parole until the 10th of June 2403. He is held at New Jersey State Prison in Trenton. Eight days later, Cullen appeared before Lehigh County Judge William H. Platt in Pennsylvania. Angry at the judge, he repeated the chant for 30 minutes until Platt had him gagged with cloth and duct tape. He kept trying to repeat it even then. Platt added six life sentences. Under Pennsylvania law, a life sentence carries no possibility of parole. Cullen continues to help law enforcement identify other victims under his plea agreement.

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• 6. A Kidney for Ernie

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  In August 2005, with sentencing still ahead, Cullen heard from a woman named Pat Peckham about her son Ernie. Ernie had contracted strep in 2002 and had not noticed the infection spreading. It overloaded the tiny filters in both his kidneys, and he now needed dialysis three days a week. Doctors placed him on a seven-year waiting list for a transplant. His friends and family were medically ineligible to donate, and a perfect six-for-six tissue match with a stranger was, in the account's words, incalculably small.

  A plea in a local newspaper drew no response, so Pat turned to Cullen. He was the estranged ex-boyfriend of her daughter and the father of her grandchild. Cullen knew Ernie, who was ten years younger than him, married with four children, and employed shaping metal in Farmingdale. Judge Armstrong signed an order for a blood test, and Stony Brook University Hospital on Long Island compared Cullen's antigens with Ernie's. They matched. Pat decided to hide the donor's identity, believing her son would refuse the kidney if it came from Cullen.

  When news of the match spread, the prosecutor and the victims' families were up in arms. They feared Cullen would be taken to a hospital where he could kill somebody or himself. Johnnie Mask, New Jersey's deputy public defender, said Cullen was so determined to help Ernie that he threatened to stop cooperating with detectives. That step could have exposed him to the death penalty. It was also reported that he threatened to skip his sentencing hearing unless he was allowed to donate. Cullen denied trying to trade his court appearance for the operation. State officials insisted he be sentenced first.

  After the 2006 sentencing, Judge Armstrong ordered the kidney removed at a New Jersey hospital certified by the Department of Corrections and then moved to New York for implantation. His order also required Ernie's insurance to cover every cost and the surgeons to be certified by the New Jersey Board of Medical Examiners. Mask said he suspected someone in the Department of Corrections or the attorney general's office did not want the donation to happen. He noted that he had direct access to Attorney General Peter C. Harvey early on, but later most top officials were told not to speak with him. John Hagerty, a spokesperson for the Division of Criminal Justice, denied this. He said the conditions reflected that Cullen was not a free man but a serial killer who could not travel willy nilly.

  On the 20th of August 2006, Mask confirmed that a social worker had told him the kidney had been removed. The hospital's name was withheld for security reasons, though Mask suspected St. Francis Medical Center in Trenton, which has a secure prison wing. The kidney was flown to Stony Brook University Hospital. Cullen stayed in the hospital several days before going back to prison in Trenton.

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• 7. Motives and Reform

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  Cullen gave detectives several explanations for his killings. He said he overdosed patients to spare them from cardiac or respiratory arrest and the Code Blue emergency that follows. He told them he could not bear to witness, or even hear about, efforts to revive someone. He also said he wanted to end suffering and keep hospital staff from treating patients as less than human.

  The record does not fit that story neatly. Not all his victims were terminal. Florian Gall, for example, had been expected to recover. The nurse Lynn Tester told police that many victims were people on the mend. Cullen said that although he often watched a patient suffer for days, each decision to kill came on impulse. In December 2003 he told detectives he had lived most of his life in a fog and had blacked out his memories of most of the killings. He could not say how many people he killed or why he chose them. At times he flatly denied killing anyone at a given hospital, then admitted involvement after reviewing the medical records.

  He slipped from hospital to hospital largely because the law asked so little of employers. New Jersey and Pennsylvania, like most states, required reports of suspicious deaths only in the most flagrant cases, and the penalties for staying silent were minor. Many states also gave investigators no authority to learn who had employed a worker before. Employers feared that investigating, or giving an honest bad reference, would invite lawsuits. According to detectives and Cullen himself, several hospitals suspected him of harming or killing patients but did not take appropriate legal action.

  Some individual workers acted on their own. Some quietly contacted nearby hospitals, or spoke privately to their superiors, to urge that Cullen not be hired. In June 2001, he took a job at Sacred Heart Hospital in Allentown. A nurse who had heard rumors about him at Easton Hospital warned her coworkers, and the nurses threatened to quit en masse unless he was dismissed immediately. He was.

  The Cullen case pushed Pennsylvania, New Jersey, and 35 other states to adopt laws encouraging employers to give honest assessments of job performance. The laws also protect those who report medical errors. New Jersey's laws became the model for other states. The 2004 Patient Safety Act made hospitals more responsible for reporting serious preventable adverse events. The 2005 Enhancement Act added that hospitals must report certain employee details to the New Jersey Division of Consumer Affairs and keep complaints and disciplinary records about patient care for at least seven years.

  After his arrest, more than 150 families of patients who died at Somerset Medical Center contacted law enforcement fearing Cullen's involvement. Somerset County prosecutor Wayne Forrest said almost 50 of those were later ruled out. St. Luke's University Hospital took 18 calls from anxious former patients or relatives, though only four concerned patients treated in its cardiac unit while Cullen worked there.

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• 8. Lawsuits and Screens

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  In 2008, after four years of litigation, the families of 22 patients believed to be Cullen's victims reached a confidential settlement with Somerset Medical Center, Hunterdon Medical Center, and Warren Hospital. The hospitals admitted no wrongdoing and rejected claims that administrators had failed to stop Cullen or to notify authorities about suspicions. The files and settlements for the New Jersey hospitals remain sealed.

  St. Luke's University Hospital fought its cases far more aggressively. In 2005, the families of Regina Miller and Marilyn Hall sued, claiming Cullen killed them there. Cullen said Miller and Hall were not among his victims. Lehigh County Court dismissed the suits in 2009, and an appeals court upheld that ruling in 2010. In 2011, St. Luke's countersued the families and their attorneys under Pennsylvania's Dragonetti Act, arguing they had no direct knowledge or evidence. The hospital sought $50,000 in punitive damages and over $560,000 in legal costs. That suit was dismissed. The families then used the same act to sue St. Luke's, and a jury sided with them but ordered no financial damages. Their lawyer, Clifford Haines, said the hospital had taken a very public and aggressive stance against its former patients.

  A similar countersuit in 2008 targeted Ed Shaughnessy, an Easton lawyer who had sued St. Luke's over the death of Franklin Pope, 72, and dropped the case in 2007. A Lehigh County jury dismissed the hospital's claim. In March 2010, a Lehigh County jury released St. Luke's from a suit that awarded a $95 million civil judgment against Cullen to the families of eight former patients. Because Cullen had no assets, the families appealed to hold the hospital accountable. The Pennsylvania Supreme Court denied their last appeal in September 2012. The hospital also countersued the firm behind the case, calling the lawsuits abusive and frivolous. Also in 2012, families of five patients reached a confidential settlement with Cullen and St. Luke's after eight years of litigation.

  Cullen's crimes have also reached the screen. Ulli Lommel wrote and directed Killer Nurse, a 2008 direct-to-video film loosely based on him. On the 28th of April 2013, the CBS program 60 Minutes aired an episode titled "Angel of Death," with correspondent Steve Kroft interviewing Cullen. It was the first time he spoke publicly about his crimes and motives. On the 25th of June 2020, the British channel Sky Crime aired Charles Cullen - Killing for Kindness, produced by Woodcut Mediastory.

  The Good Nurse reached Netflix on the 26th of October 2022. It is adapted from Charles Graeber's nonfiction book The Good Nurse: A True Story of Medicine, Madness, and Murder. Eddie Redmayne plays Cullen, and Jessica Chastain plays Amy Loughren, the co-worker who helped implicate him and talked with him after hours while wearing a wire for detectives. Netflix followed on the 11th of November 2022 with the documentary Capturing the Killer Nurse. It includes interviews with Cullen, his co-workers, detectives, victims' relatives, Graeber, and Loughren, along with audio of Cullen himself. A 2023 episode of the podcast Criminal returned to the story through an interview with Loughren.

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